USF COM Rank Request Form

College of Medicine RANK REQUEST UPON APPOINTMENT

GEMS Position # Date PART I

Candidate Name: Last First Middle Degree (s)

Department: Division: Associate Professor Professor Include the following:

Department Chair’s Letter of Recommendation Five Letters of Recommendation

Candidate’s Curriculum Vitae Pathway ______

DEPARTMENT COMMITTEE APPROVALS

Rank: Approved Denied Vote: ____ For ____ Against

______Chair, Department Committee Date Comments:

PART II COLLEGE COMMITTEE APPROVALS

Rank: Approved Denied Vote: ____ For ____ Against

______Chair, College Committee Date Comments:

DEAN APPROVAL

Rank Approved Denied ______Dean Date

Comments: